I read the posts on this board, including some of the horror stories - where a CPer goes to the ER for some kind of pain problem and the post often goes like this - 'Has this ever happened to you?' and you pray that it will never happen to you.

Well, this is not one of those, but today in the ER I did feel like I was starting to get that attitude from the doctor that he thought the only reason I was there was for pain drugs but all I wanted to know what was wrong and how to correct it. This attitude and treatment has happened to me before in the ER when being treated for migraines, but today, unlike other times I was able to speak up a bit and in doing so I now understood I mistook the doctor's behavior and I think I might have educated him a little as well - all in all it ended up being productive, from my perspective anyway. .

So, I came in to triage, told them I hurt my toe and listed the meds I take, topamax, vicodin and mentioned that I just finished a round of toradol. For each they asked my why I took them and I explained and for the topamax I said migraines and chronic pain and for the vicodin I said chronic back pain. Pretty simple.

When the doctor finally came to see me, sure enough he had treated me for a migraine in the past - honestly I can't remember with what (narcotic or not) so he may have had a pre-impression of me but I didn't consider this until after the initial interaction with him. He came in the room and said, Hi I'm doctor so-and-so and put out his hand to shake mine, and I shook it and introducted myself and told him that I remembered him, that he had helped with a migraine a couple of years ago. He looked at my chart and the first thing he asked me was (of course) what do you take the vicodin for? Now I know everything was listed in the chart but he never asked me about the other meds - just the vicodin. I told him I suffered from chronic pain and it was in my back. From there he moved to the issue at hand which was my toe.

After touching my toe a few times and attempting to move it a little and seeing that it caused me pain and then determining at about what time I thought I had hurt it (it was about 6 hours prior - I had hurt it around 1:30am) he asked me if I had taken any of my vicodin for the pain. I hadn't, so I said no. He just looked at me and he shook he head (from left to right) and said 'Well I don't understand that at all. You are telling me that you have vicodin and that your toe hurts and that you had trouble sleeping becuase of it, yet you didn't take any of your vicodin, that just doesn't make sense." I was thrown off guard, and I very recently upped my dosage of topamax so the brain wasn't firing quickly, plus I was tired, plus I was hurting and then I was immediately wondering what the heck this doctor was implying by this question. I did manage to respond to him, something like 'I only take it for my back pain, but it was kind of mumbled and he was out the door before I really had digested what had happened.

So as ER visits go, I had a lot of time sitting in that room thinking about his question. First I knew that even if he gave me a script for some pain med I would have to decline because of my PM contract and then I realized maybe he didn't know that and that maybe just because I said I took vicodin for chronic pain, maybe he didn't understand what that really meant to me - a pain clinic and a contract (although I did tell him the doctors name, and this is a small town and when I said the PMs name he did seem like he recognized it.)

So I waited and waited for him to come back. I had decided I was going to very politely and tactfully answer his question now that I had some time to think about it. When he returned and told me what the xRays and blood work told him, I asked him if possible I would like to address his question and concern of why I didn't take any vicodin and he very nicely said 'yea sure' - he really seemed like he wanted to know the answer. So I explained that I was enrolled in a PM clinic and that I was allotted a certain amount of vicodin a day and that I could not exceed it becuase of the contract and also doing so would cause me to go over the safe amount of tylenol per day. I further explained, that given that the injury occurred in the middle of the night, I had really already taken the previous days allotment and given that I have to manage my own pain with a pre-allotted amount that it was still very early for the next day to start so if I took one now I may have to 'pay' later but more importantly my PM contract and prescription says that I will take the vicodin for my back pain. I then explained that it is of the upmost importance to me to not break or appear to break my contract in anyway, because if I do I loose my only means of having some control over my pain and quality of life. That having the privilege of receiving these medications has a respsonsibility that comes with it and meant I couldn't just take the pills whenever I wanted and as much as I wanted. I then finished with that the only reason I complained of the pain of my toe was because I felt it was an important symptom of the problem and that I was not after narcotic pain medication that in fact I could not accept any from him.

He listened to me the whole way through, he smiled and he said, 'well that makes sense'. He said he didn't understand that I was in a Pain Management clinic, he thought I just had vicodin available from my GP. He then wrote my prescription for toradol and then said he didn't know what else to do for the pain and said I should call my PM to ask if I could take the vicodin for the toe problem and I said yes but only to make things easy as I had no intentions of calling my PM to ask to take my vicodin for my toe - my fear is that it makes me look like I am drug seeking to the PM and I can live with a little toe problem for a few days, couple weeks max. Also I will still be taking the vicodin for the back pain and in theory that will help, the toe pain is a non-issue compared to the back, but I didn't want to go into all that with him - I already accomploshed what I set out to do.

So upon reflection of the whole thing I think there was a miscommunication or a lack of communication in the beginning (my fault) - he didn't know I was in a Pain Management clinic because I didn't tell him - all I said was I had chronic pain (and I assumed he would know chronic pain meant a Pain Manangement Clinic and a contract. ) Then I mistook his genuine confusion over what a normal person would do in my circumstance as him thinking I was drug seeking and this is because I am over-sensitive to this from a couple bad experiences with migraines in the ER - now I know I need to try to be fair.

The good news is I believe I really turned it around effectively. I didn't get on a soap box and just tried to talk to him as if I was talking to someone on this board instead of a doctor and I used a lot of things I have learned on this board. So I decided I would share for whoever is interested and besides now I am both stuck off my feet for a while and tirating up on the topamax so I an quite inclined to be posting - but I will stop (for now).

People who see a PM Dr., that get regular pain meds, that have to go to the ER, shoukd bring their pain pills with them and the PM info. Maybe if the ER see's you have pain med's, they wont think you are there to try to get drug's. That way you will be treated better "maybe".

That happened to me a little over a year ago. I had an extremely painful kidney stone attack and I was literally rolling on the ER floor in pain. I had brought my meds and I think they never considered that I might be a drug seeker.

I did have to wait in the waiting room for a few hours, but they gave me a shot of dilaudid and the pain went away immediately. I never filled the script they gave me and I did tell my PM Doc the whole story.

So yes, if you bring your meds, you might be seen as being a legit patient.

Hi DogMom,
I'm so glad you shared your story. I had a similar experience when I was experiencing pain from my gall bladder, which I had to have removed 2 weeks later. I will definitely keep your approach in mind if and when I got to the ER again! I went in to the ER with severe abdominal pain. He looked at my list of meds and his first words, after introducing himself, and without examining me, was that people on pain meds experience pain more severely and that someone on pain meds might complain a lot more about a sprained ankle than someone who wasn't?! So in his opinion I might have just have indigestion! Btw...I was so out of it with the pain I was speechless. Anyway, he then said he was going to give me some pain meds because he wasn't worried about me becoming addicted to them because based on my med list I already was. I had told him that I was there because while I take pain meds for my back pain, this pain was new and I didn't think it was right to just take my meds for any kind of pain. I wanted to find out what was going on. I had also told him that the pain got worse when I ate, and that I often ended up throwing up later. So his solution....give me pain meds, and order me a cheese sandwich...if I didn't throw up, send me home. I was so astonished and furious, I left. I couldn't believe it. No ultrasounds or tests. I clearly did not do as you did, and communicate that I wasn't after pain meds, but rather tests to find out what was going on. It seems like some docs read the list of pain meds, and you are discriminated against before you open your mouth. So I think doing as you suggest and communicating right off the bat that you are not after pain meds and that you already work with a PM clinic is a good approach. I wish I had had the where with all to do that at the time. This experience still bugs me. Later I wanted to go in and tell him that I ended up having my gall bladder removed 2 weeks later. Guess it wasn't a sprained ankle after all!!

Hi Dog Mom, Wow, I am so lucky! while I go to a PM clinic, I did not have to sign a contract. The only med my pm gives me is my topa, my primary gives me my pain pills, therefore I never have any problems ever like you had. I just worry about meds being crossed--so I have to always do a lot of research and count on my pharmacist to double check what I am taking with what. What a mess!! I hope you get healed up!!